HMO Plans

Health Maintenance Organization (HMO) Advantage plans are inexpensive, with a network of reliable healthcare providers to access.

What is Medicare Advantage?

Medicare Advantage is like an all-in-one “alternative” to Original Medicare. However, it combines Original Medicare coverage with a network of healthcare providers to reduce costs. Within this network, your costs are greatly reduced, especially compared to what you would be paying under Original Medicare alone.

There are 5 different Advantage plans to choose from—Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-For-Service (PFFS), Dual-Eligible Special Needs Plan (D-SNP), and Medicare Medical Savings Account (MSA). Each plan will vary in the type and range of network it offers at a relative price. The most common plans to consider, then, are HMO and PPO plans.

How Do HMO Plans Work?

Medicare HMO plans, like Advantage plans in general, provide a specific network of healthcare providers for you to access at a reduced rate. HMO plans are unique in that they take extra measures to reduce your costs.

Oftentimes, insurance companies will require you to select a primary care physician (PCP), who will determine what treatment you need. You will then have to visit this PCP before you can receive any specialist care or treatment.

You will also have to pay the entire cost of the service if you venture outside of the network. Also, they may provide some additional benefits such as limited dental, vision, and hearing, as well as Part D coverage.

The Benefits of an HMO Plan

HMO plans don’t cost much. Especially compared with the other popular option, PPO plans, HMO premiums and deductibles are relatively low. Because they are more restricted in their network range and often require a PCP and specialist referral, providers are able to greatly reduce your out-of-pocket costs.

Potential Drawbacks of an HMO Plan

On the other hand, many people find this network too restrictive. Reduced costs are, of course, a major benefit, but some people are unable (or unwilling) to sacrifice flexibility for a lower price. There is also virtually no coverage for out-of-network care, while PPO plans allow for some out-of-network coverage.

HMO plans, though more restrictive, still offer a lot of excellent, necessary coverage—there is a reason so many people purchase it. Essentially, you are sacrificing some flexibility for lower costs.

Compare and Find the Right HMO Plan with Schwenker Senior Insurance

Still can’t decide if an HMO plan is right for you? Or, if you know you want an HMO plan, how can you find a provider in your area? Schwenker Senior Insurance will help, all you need to do is give us a call at 563-579-6116, or email us at

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